Salpingectomy For Ovarian Cancer Prevention Research Articles

Opportunistic Salpingectomy for Ovarian Cancer Prevention: A Call for Action.

Rius, Mariona MD, PHD1; Carugno, José MD2; Maurico S, Abrao MD, PHD3; Carmona, Francisco MD PHD Author Information

Racial and ethnic differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States

Clinicians in the United States have rapidly adopted opportunistic salpingectomy for ovarian cancer prevention. However, little is known about racial and ethnic differences in opportunistic salpingectomy adoption. Surgical innovations in gynecology may be adopted differentially across racial and ethnic groups, exacerbating current disparities in quality of care. This study aimed to evaluate racial and ethnic differences in opportunistic salpingectomy adoption across inpatient and outpatient settings and assess the effect of national guidelines supporting opportunistic salpingectomy use on these differences. A sample of 650,905 women aged 18 to 50 years undergoing hysterectomy with ovarian conservation or surgical sterilization from 2011 to 2018 was identified using the Premier Healthcare Database, an all-payer hospital administrative database, including more than 700 hospitals across the United States. The association between race and ethnicity and opportunistic salpingectomy use was examined using multivariable-adjusted mixed-effects log-binomial regression models accounting for hospital-level clustering. Models included race and ethnicity by year of surgery (2011-2013 [before guideline] and 2014-2018 [after guideline]) interaction term to test whether racial and ethnic differences in opportunistic salpingectomy adoption changed with the release of national guidelines supporting opportunistic salpingectomy use. From 2011 to 2018, 82,792 women underwent hysterectomy and opportunistic salpingectomy (non-Hispanic White, 60.3%; non-Hispanic Black, 18.8%; Hispanic, 12.2%; non-Hispanic other race, 8.7%) and 23,398 women underwent opportunistic salpingectomy for sterilization (non-Hispanic White, 64.7%; non-Hispanic Black, 10.8%; Hispanic, 16.7%; non-Hispanic other race, 7.8%). The proportion of hysterectomy procedures involving an opportunistic salpingectomy increased from 6.3% in 2011 to 59.7% in 2018 (9.5-fold increase), and the proportion of sterilization procedures involving an opportunistic salpingectomy increased from 0.7% in 2011 to 19.4% in 2018 (27.7-fold increase). In multivariable-adjusted models, non-Hispanic Black (risk ratio, 0.94; 95% confidence interval, 0.92-0.97), Hispanic (risk ratio, 0.98; 95% confidence interval, 0.95-1.00), and non-Hispanic other race women (risk ratio, 0.93; 95% confidence interval, 0.90-0.96) were less likely to undergo hysterectomy and opportunistic salpingectomy than non-Hispanic White women. A significant interaction between race and ethnicity and year of surgery was noted in non-Hispanic Black compared with non-Hispanic White women (P<.001), with a reduction in differences in hysterectomy and opportunistic salpingectomy use after national guideline release (risk ratio2011-2013, 0.80 [95% confidence interval, 0.73-0.88]; risk ratio2014-2018, 0.98 [95% confidence interval, 0.95-1.01]). Moreover, non-Hispanic Black women were less likely to undergo an opportunistic salpingectomy for sterilization than non-Hispanic White women (risk ratio, 0.91; 95% confidence interval, 0.88-0.95), with no difference by year of surgery (P=.62). Stratified analyses by hysterectomy route and age at surgery revealed similar results. Although opportunistic salpingectomy for ovarian cancer prevention has been rapidly adopted in the United States, our findings suggested that its adoption has not been equitable across racial and ethnic groups. Non-Hispanic Black, Hispanic, and non-Hispanic other race women were less likely to undergo opportunistic salpingectomy than non-Hispanic White women even after adjusting for sociodemographic, clinical, procedural, hospital, and provider characteristics. These differences persisted after the release of national guidelines supporting opportunistic salpingectomy use. Future research should focus on understanding the reasons for these differences to inform interventions that promote equity in opportunistic salpingectomy use.

Outcomes From Opportunistic Salpingectomy for Ovarian Cancer Prevention

Opportunistic salpingectomy (OS), which is the removal of fallopian tubes during hysterectomy or instead of tubal ligation without removal of ovaries, is recommended to prevent ovarian cancer, particularly serous ovarian cancer. However, the effectiveness of OS is still undetermined. To examine observed vs expected rates of ovarian cancer among individuals who have undergone OS. This is a population-based, retrospective cohort study of all individuals in British Columbia, Canada, who underwent OS or a control surgery (hysterectomy alone or tubal ligation) between 2008 and 2017, with follow-up until December 31, 2017. Those with any gynecological cancer diagnosed before or within 6 months of their procedure were excluded. Data analysis was performed from April to August 2021. Removal of both fallopian tubes at the time of hysterectomy or instead of tubal ligation while leaving ovaries intact. An ovarian cancer diagnosis listed in the British Columbia Cancer Registry. Age-specific rates of epithelial and serous ovarian cancer in the control group were combined with the specific follow-up time in the OS group to calculate expected numbers (and 95% CIs) of ovarian cancers in the OS group. These were compared with observed numbers. Age-adjusted expected and observed numbers of breast and colorectal cancers were also examined in the OS group. There were 25 889 individuals who underwent OS (mean [SD] age, 40.2 [7.1] years; median [IQR] follow-up, 3.2 [1.6-5.1] years) and 32 080 who underwent hysterectomy alone or tubal ligation (mean [SD] age, 38.2 [7.9] years; median [IQR] follow-up, 7.3 [4.6-8.7] years). There were no serous ovarian cancers in the OS group and 5 or fewer epithelial ovarian cancers. The age-adjusted expected number was 5.27 (95% CI, 1.78-19.29) serous cancers and 8.68 (95% CI, 3.36-26.58) epithelial ovarian cancers. Age-adjusted expected vs observed numbers of breast cancers (22.1 expected vs 23 observed) and colorectal cancers (9.35 expected vs 8 observed) were not significantly different. In this cohort study, the OS group had significantly fewer serous and epithelial ovarian cancers than were expected according to the rate at which they arose in the control group. These findings suggest that OS is associated with reduced ovarian cancer risk.

Abstract PO-230: Racial differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States

Abstract Introduction: Opportunistic salpingectomy (OS), the removal of the fallopian tubes during benign gynecologic surgery, has been rapidly adopted by clinicians in the U.S. as a strategy for ovarian cancer prevention. However, little is known about racial differences in OS adoption. As with other medical innovations, surgical innovations in gynecology may be adopted differentially across racial groups, exacerbating disparities in care quality. We examined racial differences in OS adoption in a population-based sample of inpatient and outpatient surgeries. Methods: A cohort of 809,911 women aged 18-50 years undergoing hysterectomy with ovarian conservation or surgical sterilization from 2011-2018 was identified using the Premier Healthcare Database, a large geographically diverse all-payer insurance claims database including over 600 acute care hospitals across the U.S. OS adoption was examined by race/ethnicity (non-Hispanic white [NHW], non-Hispanic Black [NHB], Hispanic, other) using multivariable-adjusted log-binomial regression models accounting for hospital-level clustering. Models included a race/ethnicity by year of surgery (2011-2013 [before guideline] vs. 2014-2018 [after guideline]) interaction term to test whether racial differences in OS adoption changed with the release of national guidelines supporting OS use. Results: From 2011-2018, 104,276 hysterectomy and OS (NHW: 60.1%, NHB: 18.8%, Hispanic: 11.4%, other: 9.7%) and 28,015 OS for sterilization (NHW: 65.4%, NHB: 10.0%, Hispanic: 10.6%, other: 14.0%) were performed. The proportion of benign hysterectomy procedures involving OS increased from 6.4% in 2011 to 62.3% in 2018, and the proportion of sterilization procedures involving OS increased from 0.7% in 2011 to 19.1% in 2018. After adjusting for demographic, clinical, procedural, and hospital/provider characteristics, NHB (risk ratio [RR]: 0.97; 95% CI: 0.95-0.99) and Hispanic women (RR: 0.84; 95% CI: 0.77-0.92) were significantly less likely to undergo hysterectomy and OS than NHW women. A significant interaction between race/ethnicity and year of surgery was noted in NHBs compared to NHWs, with a lower likelihood of hysterectomy and OS in NHBs undergoing surgery before but not after national guideline release (RR2011-2013: 0.82; 95% CI: 0.75-0.89; RR2014-2018: 0.99; 95% CI: 0.96-1.01). Results were similar in stratified analyses by hysterectomy route (abdominal, laparoscopic, vaginal). NHBs were also significantly less likely to undergo OS for sterilization than NHWs (RR: 0.84; 95% CI: 0.81-0.88), with no differences by year of surgery. Conclusions: Although OS for ovarian cancer prevention has been rapidly adopted into clinical practice in the U.S., our findings suggest that its adoption has not been equitable across racial groups. NHB and Hispanic women are less likely to undergo OS than NHW women even after adjusting for demographic, clinical, procedural, and hospital/provider characteristics. If these differences in OS adoption persist, disparities in ovarian cancer incidence may worsen in the future. Citation Format: Pritesh S. Karia, Yongmei Huang, Parisa Tehranifar, Kala Visvanathan, Jason D. Wright, Jeanine M. Genkinger. Racial differences in the adoption of opportunistic salpingectomy for ovarian cancer prevention in the United States [abstract]. In: Proceedings of the AACR Virtual Conference: 14th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2021 Oct 6-8. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2022;31(1 Suppl):Abstract nr PO-230.

Adoption of opportunistic salpingectomy for ovarian cancer prevention: Results from a nationwide sample of privately insured women.

1561 Background: Recent evidence indicates that the Fallopian tube is the site of origin for many high-grade serous ovarian cancers, particularly in BRCA carriers. This has led to the emergence of opportunistic salpingectomy (OS) as a novel ovarian cancer prevention strategy. Despite limited data, some national societies now recommend OS for ovarian cancer prevention during benign hysterectomy or in place of tubal ligation for sterilization in average-risk women. We assessed patient characteristics associated with increased likelihood of OS and national trends in OS adoption before and after release of recommendations. Methods: Data from MarketScan were used to identify women who underwent hysterectomy, tubal ligation, and OS from 2010-2017. Rates of OS were compared and interrupted time series analysis with segmented Poisson regression was used to examine immediate and persistent changes in OS rates before and after recommendations. Rates were calculated quarterly and models were adjusted for age and seasonality. Results: A total of 309,574 tubal ligations, 13,574 OS for sterilization, 293,000 hysterectomies, 22,798 hysterectomies with OS were included. Quarterly rates of OS for sterilization and hysterectomy with OS were 3.13 and 4.82 per 100,000 women, respectively. About 92% of OS for sterilization and 56% of hysterectomy with OS were performed in women &lt; 45 years. The most common indication for hysterectomy with OS was uterine fibroids (46%). About 8% of OS for sterilization and 10% of hysterectomy with OS were performed in women with a family history of breast or ovarian cancer. After adjusting for age and seasonality, there was a 250% immediate increase (RR: 3.50; 95% CI: 2.59-4.72) followed by a 14% (RR: 1.14; 95% CI: 1.10-1.18) persistent increase in the quarterly rate of OS for sterilization after versus before recommendation release. There was a 109% immediate increase (RR: 2.09; 95% CI: 1.15-3.81) in the quarterly rate of hysterectomy with OS after versus before recommendation release. No persistent change in the rate of hysterectomy with OS was observed. Significant declines in hysterectomy and tubal ligation rates were observed and these declines were temporally associated with the release of recommendations. Conclusions: OS for ovarian cancer prevention has rapidly diffused into clinical practice with the speed of adoption bolstered by recommendations from national societies. Future studies evaluating the overall efficacy and long-term complications of OS are needed to support its continued widespread use.

Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention.

Salpingectomy with interval oophorectomy has gained traction as an ovarian cancer prevention strategy, but is not currently recommended for high risk women. Nevertheless, some choose this approach. We aimed to understand risk perception and plans for oophorectomy in BRCA1 and BRCA2 (BRCA) mutation carriers choosing salpingectomy for ovarian cancer prevention. This was a longitudinal survey study of BRCA mutation carriers who underwent bilateral salpingectomy to reduce ovarian cancer risk. An initial written questionnaire and telephone interview was followed by annual phone interviews. 22 women with BRCA mutations were enrolled. Median follow-up was three years. The median age at salpingectomy was 39.5 years (range 27-49). Perceived lifetime ovarian cancer risk decreased by half after salpingectomy (median risk reduction 25%, range 0-40%). At final follow-up, five (22.7%) had undergone oophorectomy and five women (22.7%) were not planning to undergo completion oophorectomy. BRCA mutation carriers who had salpingectomy after the recommended age of prophylactic surgery (vs. before the recommended age) were less likely to plan for future oophorectomy (28.6% vs. 66.7%, p = 0.037). All women were satisfied with their decision to undergo salpingectomy with eighteen (81.8%) expressing decreased cancer-related worry. There were no diagnoses of ovarian cancer during our study period. In conclusion, most BRCA mutation carriers undergoing risk-reducing salpingectomy are satisfied with their decision and have lower risk perception after salpingectomy, though some older mutation carriers did not plan on future oophorectomy. Salpingectomy with delayed oophorectomy in BRCA mutation carriers remains investigational and should preferably be performed within a clinical trial to prevent introduction of an innovation before safety has been proven.

A low-cost approach to salpingectomy at cesarean delivery

There is increasing adoption of opportunistic salpingectomy for ovarian cancer prevention at the time of gynecologic surgery, which includes the postpartum period. However, there is no consensus on an ideal surgical approach for the parturient vasculature. We describe a safe, low-cost, and accessible approach for bilateral salpingectomy during cesarean delivery that we call the "Mesosalpinx Isolation Salpingectomy Technique" (MIST) that can guide institutions to standardize their postpartum salpingectomy procedures when advanced vessel-sealing devices are not available. In the MIST technique, avascular windows are created within the mesosalpinx close to the tubal vessels. The vasculature is thus fully skeletonized and isolated from the adjacent mesosalpinx before suture ligation, which ensures security of the free-tie to the individual vessels and avoids sharp injury to the mesosalpinx. Not using vessel-sealing devices also eliminates the risk of thermal injury to the adjacent ovarian tissue and vasculature and potentially achieves a cost-savings for the hospital and patient. MIST has been performed in 141 cesarean deliveries in the past 4 years. There were no noted bleeding complications during the salpingectomy procedure, blood transfusions, or instances of postoperative surgical reexploration. In our experience, a surgeon who is new to the procedure takes approximately 15 minutes to complete a bilateral salpingectomy. Those surgeons who are experienced in MIST need only 5 minutes. A video is included that demonstrates the technique.

Nationwide salpingectomy rates for an indication of permanent contraception before and after published practice guidelines

ObjectiveTo identify the nationwide rate of salpingectomy for permanent contraception before and after the January 2015 American College of Obstetricians and Gynecologists (ACOG) Committee Opinion, Salpingectomy for Ovarian Cancer Prevention. Study DesignUsing ICD-9/10 diagnosis and procedure codes within the Vizient database, we identify permanent contraception procedures with and without salpingectomy, among females 18–50 years old between January 2013 and January 2017. Subject, hospital characteristics and costs information were recorded. To determine the changes in salpingectomy rates over time analysis was conducted using the Cochran-Armitage trend test and logistic regression models. ResultsA total of 211,312 women across 303 Vizient-member hospitals underwent a permanent contraception procedure over the study period. Of these, 174,930 subjects were selected from 160 hospitals that contributed data over the full 49-month period. Overall, 25,882 (14.8%) subjects underwent a salpingectomy for an indication of permanent contraception. Higher salpingectomy rates were identified among larger (p<.0001), teaching (p<.0001) hospitals versus smaller, non-teaching hospitals and in subjects with commercial/private payers (p<.0001). A lower salpingectomy rate was observed in Northeast hospitals (p<.0001). Median total hospital costs differed by $25 between permanent contraceptions performed with and without salpingectomy. The proportion of salpingectomies was <1% in January 2013 slowly rising to 20.6% in October 2015 and then 61.5% by January 2017 (p<.0001). During the pre-opinion period (Jan 2013–Dec 2014) the monthly increase in the odds of salpingectomy was 6% (OR 1.06, 95% CI 1.05, 1.06) compared to a monthly increase of 18% (OR 1.18, 95% CI 1.18, 1.18) during the post-opinion period (Jan 2015–Jan 2017). ConclusionsThe nationwide rate of salpingectomies for permanent contraception has steadily increased among Vizient-member hospitals since the ACOG committee opinion. ImplicationsSalpingectomy as an approach to permanent contraception in the United States is increasing since the ACOG Committee Opinion with differing utilization rates by hospital type, region, size, and patient payer types. Physician behavior may be influenced by practice guidelines but other factors mitigate the effect.

The Trend, Feasibility, and Safety of Salpingectomy as a form of Permanent Sterilization

To assess the change in the rate of laparoscopic salpingectomy for sterilization after the release of the November 2013 Society of Gynecologic Oncology Clinical Practice Statement and the January 2015 American College of Obstetricians and Gynecologists Committee Opinion: Salpingectomy for Ovarian Cancer Prevention. We hypothesized there would be an increase in salpingectomy as a percentage of total laparoscopic sterilizations performed without an increase in complications when compared with conventional bilateral tubal ligation (BTL). A retrospective cohort study. Four university-affiliated hospitals in Houston, TX, and New York, NY. All women 21 years or older who underwent interval laparoscopic permanent sterilization between April 2013 and September 2016. Sterilization by bilateral salpingectomy or conventional tubal ligation. There were 454 sterilization procedures identified; 60% were BTLs, whereas 40% were salpingectomies. The rate of use of salpingectomy significantly increased from 5% to 9% in 2013 to 2014 to 78% by 2016. There was no significant difference in intraoperative or postoperative complications or estimated blood loss. The mean procedure time was 54 minutes for salpingectomy compared with 45 minutes for BTL (p <.0001). Salpingectomy was more likely to require 3 ports compared with 2 ports for BTL (p <.0001). The Society of Gynecologic Oncology and the American College of Obstetricians and Gynecologists' support of salpingectomy for ovarian cancer prevention increased its use for sterilization. Based on this study, laparoscopic bilateral salpingectomy is a safe method of sterilization without an increase in perioperative risk compared with conventional tubal ligation. Physicians should incorporate these findings and implications when counseling patients regarding contraception and permanent sterilization.

Gynecological Cancers-the Changing Paradigm.

Outstanding research in the last few decades led to newer insights into the management of gynecological cancers. In the preventive arena, the efficacy and safety of HPV vaccination are well accepted and is now in addition to bi- and quadrivalent vaccines; there is a nonavalent vaccine against nine oncogenic HPV strains. Recent studies also looked into the dosaging schedules and age of vaccination against HPV to improve the vaccine efficacy and coverage. HPV testing is now approved as a primary screening test for cervical cancer in women aged more than 30years with better sensitivity than the traditional cytology. Opportunistic salpingectomy for ovarian cancer prevention and neoadjuvant chemotherapy for advanced ovarian cancers are accepted practices. The role of personalized medicine in ovarian cancer and comprehensive genomic analysis of endometrial cancers are also covered in this review.

Salpingectomy for ovarian cancer prevention at the time of cesarean delivery: Comparison of outcomes of surgical technique

Salpingectomy for ovarian cancer prevention at the time of cesarean delivery: Comparison of outcomes of surgical technique

A nationwide analysis of salpingectomy rates for sterilization following the 2015 American College of Obstetricians and Gynecologists committee opinion, “Salpingectomy for ovarian cancer prevention”

A nationwide analysis of salpingectomy rates for sterilization following the 2015 American College of Obstetricians and Gynecologists committee opinion, “Salpingectomy for ovarian cancer prevention”

Cost-effectiveness of opportunistic salpingectomy for ovarian cancer prevention

ObjectivesData suggesting a link between the fallopian tube and ovarian cancer have led to an increase in rates of salpingectomy at the time of pelvic surgery, a practice known as opportunistic salpingectomy (OS). However, the potential benefits, risks and costs for this new practice are not well established. Our objective was to assess the cost-effectiveness of opportunistic salpingectomy at the time of laparoscopic permanent contraception or hysterectomy for benign indications. MethodsWe created two models to compare the cost-effectiveness of salpingectomy versus usual care. The hypothetical study population is 50,000 women aged 45 undergoing laparoscopic hysterectomy with ovarian preservation for benign indications, and 300,000 women aged 35 undergoing laparoscopic permanent contraception. SEER data were used for probabilities of ovarian cancer cases and deaths. The ovarian cancer risk reduction, complication rates, utilities and associated costs were obtained from published literature. Sensitivity analyses and Monte Carlo simulation were performed, and incremental cost-effectiveness ratios (ICERs) were calculated to determine the cost per quality adjusted life year (QALY) gained. ResultsIn the laparoscopic hysterectomy cohort, OS is cost saving and would yield $23.9 million in health care dollars saved. In the laparoscopic permanent contraception cohort, OS is cost-effective with an ICER of $31,432/QALY compared to tubal ligation, and remains cost-effective as long as it reduces ovarian cancer risk by 54%. Monte Carlo simulation demonstrated cost-effectiveness with hysterectomy and permanent contraception in 62.3% and 55% of trials, respectively. ConclusionsOpportunistic salpingectomy for low-risk women undergoing pelvic surgery may be a cost-effective strategy for decreasing ovarian cancer risk at time of hysterectomy or permanent contraception. In our model, salpingectomy was cost-effective with both procedures, but the advantage greater at time of hysterectomy.

Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention

Perceptions of risk and reward in BRCA1 and BRCA2 mutation carriers choosing salpingectomy for ovarian cancer prevention

Opportunistic bilateral salpingectomy during benign gynecological surgery for ovarian cancer prevention: a survey of Gynecologic Oncology Committee of Japan Society of Obstetrics and Gynecology.

ObjectiveRecent evidence has supported the concept that epithelial ovarian cancer (EOC) arises from the cells of the fallopian tube or endometrium. This study investigated current practice in Japan with respect to performing opportunistic bilateral salpingectomy (OBS) during gynecological surgery for benign disease for Ovarian Cancer Prevention.MethodsWe mailed a questionnaire to 767 hospitals and clinics, comprising 628 accredited training institutions of the Japan Society of Obstetrics and Gynecology (JSOG), Japan Society of Gynecologic Oncology (JSGO), or Japan Society of Gynecologic and Obstetric Endoscopy and Minimally Invasive Therapy (JSGOE) and 139 private institutions with at least one JSGOE-certified licensed gynecologic laparoscopist.ResultsAmong the 767 institutions, 444 (57.9%) provided responses, including 91 (20.6%) that were both JSGOE and JSGO accredited, 71 (16.0%) that were only JSGO accredited, 88 (19.8%) that were only JSGOE accredited, and 194 (43.7%) that were unaccredited. It was found that awareness and performance of OBS largely depended on the JSGO and/or JSGOE accreditation status. OBS was only performed at 54.0% of responding institutions and just 6.8% of the institutions were willing to participate in randomized controlled trials to validate this method for reducing the incidence of ovarian cancer.ConclusionThe JSOG Gynecologic Tumor Committee will announce its opinion on salpingectomy for ovarian cancer prevention to all JSOG members and will develop a system for monitoring the number of OBS procedures in Japan.

The performance and safety of bilateral salpingectomy for ovarian cancer prevention in the United States

Ovarian cancer is the leading cause of death due to gynecologic malignancy and the fifth most common cause of cancer deaths in developed countries. Recent evidence has indicated that the most common and lethal form of ovarian cancer originates in the distal fallopian tube, and recommendations for surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal sterilization) have been made, most recently by the American Congress of Obstetricians and Gynecologists. We sought to assess the uptake and perioperative safety of bilateral salpingectomy at the time of hysterectomy and tubal sterilization in the United States and to examine the factors associated with increased likelihood of bilateral salpingectomy. The Nationwide Inpatient Sample was used to identify all girls and women 15 years or older without gynecologic cancer who underwent inpatient hysterectomy or tubal sterilization, with and without bilateral salpingectomy, from 2008 through 2013. Weighted estimates of national rates of these procedures were calculated and the number of procedures performed estimated. Safety was assessed by examining rates of blood transfusions, perioperative complications, postprocedural infection, and fever, and adjusted odds ratios were calculated comparing hysterectomy with salpingectomy with hysterectomy alone. We included 425,180 girls and women who underwent inpatient hysterectomy from 2008 through 2013 representing a national cohort of 2,036,449 (95% confidence interval, 1,959,374-2,113,525) girls and women. There was an increase in the uptake of hysterectomy with bilateral salpingectomy of 371% across the study period, with 7.7% of all hysterectomies including bilateral salpingectomy in 2013 (15.8% among girls and women retaining their ovaries). There were only 1195 salpingectomies for sterilization, thus no further comparisons were possible. In the girls and women who had hysterectomy with bilateral salpingectomy, there was no increased risk for blood transfusion (adjusted odds ratio, 0.95; 95% confidence interval, 0.86-1.05) postoperative complications (adjusted odds ratio, 0.97; 95% confidence interval, 0.88-1.07), postoperative infections (adjusted odds ratio, 1.26; 95% confidence interval, 0.90-1.78), or fevers (adjusted odds ratio, 1.33; 95% confidence interval, 1.00-1.77) compared with women undergoing hysterectomy alone. Younger age, private for-profit hospital setting, larger hospital size, and indication for hysterectomy were all associated with increased likelihood of getting a hysterectomy with bilateral salpingectomy in women retaining their ovaries. Our results suggest that hysterectomy with bilateral salpingectomy is significantly increasing in the United States and is not associated with increased risks of postoperative complications.

Abstract B20: Uptake and safety of bilateral salpingectomy for ovarian cancer prevention in the United States.

Abstract Ovarian cancer is the leading cause of death due to gynecologic malignancy and the fifth most common cause of cancer deaths in developed countries. Recent evidence has indicated that the most common and lethal form of ovarian cancer originates in the distal fallopian tube, making surgical removal of the fallopian tube (bilateral salpingectomy) at the time of other gynecologic surgeries (particularly hysterectomy and tubal ligation) a potential ovarian cancer prevention strategy. We aimed to assess the uptake and perioperative safety of bilateral salpingectomy (BS) as an ovarian cancer risk-reduction strategy in the United States and to examine the factors associated with increased likelihood of getting a BS with benign gynecologic surgery. The Nationwide Inpatient Sample was used to identify all women 15 years or older who underwent inpatient hysterectomy or tubal sterilization between 2008 and 2012. Weighted estimates of national trends were calculated and the number of procedures performed estimated. Safety was assessed by examining rates of blood transfusions, perioperative complications, post procedural infection and fever, and adjusted odds ratios were calculated comparing hysterectomy with salpingectomy with hysterectomy alone. There was an increase in the uptake of hysterectomy with BS of 129% across the study period; however, this represented only 1.9% of total hysterectomies. There were only 233 salpingectomies for sterilization, thus no further comparisons were possible in this group. In the hysterectomy with BS women, there was no statistically significantly increased risk for blood transfusion (aOR, 0.89; 95%CI 0.79, 1.00) post-operative complications (aOR, 0.94; 95%CI 0.83, 1.07), post-operative infections (aOR, 1.44; 95%CI 0.97, 2.14) or fevers (aOR, 1.33; 1.00, 1.77) compared with women undergoing hysterectomy alone. Being younger, having more chronic conditions, being in a private, for profit hospital, indication for hysterectomy, and not being operated on in a small hospital were all associated with increased likelihood of getting a hysterectomy with BS compared to getting a hysterectomy alone. Our results suggest that, despite some significant growth, relatively few patients were receiving BS in the United States between 2008 and 2012. Given that the Society for Gynecologic Oncology and the American College of Obstetrics and Gynecology published recommendations to discuss BS with patients undergoing hysterectomy or tubal ligation in 2013 and 2015 respectively, and that our data extends only to 2012 we expect that rates may have risen more dramatically following those recommendations. Despite not reaching statistical significance, the aORs for both post-operative infection and fever were suggestive of an increased risk in women undergoing hysterectomy with BS. We hypothesize this is related to indication for BS,including hydrosalpinx and pelvic inflammatory disease, but recommend further research. Citation Format: Gillian Hanley, Jessica McAlpine, Leigh Pearce. Uptake and safety of bilateral salpingectomy for ovarian cancer prevention in the United States. [abstract]. In: Proceedings of the AACR Special Conference on Advances in Ovarian Cancer Research: Exploiting Vulnerabilities; Oct 17-20, 2015; Orlando, FL. Philadelphia (PA): AACR; Clin Cancer Res 2016;22(2 Suppl):Abstract nr B20.

Opportunistic salpingectomy for ovarian cancer prevention.

Recently accumulated evidence has strongly indicated that the fallopian tube is the site of origin for the majority of high-grade serous ovarian or peritoneal carcinomas. As a result, recommendations have been made to change surgical practice in women at general population risk for ovarian cancer and perform bilateral salpingectomy at the time of hysterectomy without oophorectomy and in lieu of tubal ligation, a practice that has been termed opportunistic salpingectomy (OS). Despite suggestions that bilateral salpingectomy may be used as an interim procedure in women with BRCA1/2 mutations, enabling them to delay oophorectomy, there is insufficient evidence to support this practice as a safe alternative and risk-reducing bilateral salpingo-oophorectomy remains the recommended standard of care for high-risk women. While evidence on uptake of OS is sparse, it points toward increasing practice of OS during hysterectomy. The practice of OS for sterilization purposes, although expanding, appears to be less common. Operative and perioperative complications as measured by administered blood transfusions, hospital length of stay and readmissions were not increased with the addition of OS either at time of hysterectomy or for sterilization. Additional operating room time was 16 and 10 min for OS with hysterectomy and OS for sterilization, respectively. Short-term studies of the consequences of OS on ovarian function indicate no difference between women undergoing hysterectomy alone and hysterectomy with OS, but no long-term data exist. There is emerging evidence of effectiveness of excisional sterilization on reducing ovarian cancer rates from Rochester (OR = 0.36 95 % CI 0.13, 1.02), and bilateral salpingectomy from Denmark (OR = 0.58 95 % CI 0.36, 0.95) and Sweden (HR = 0.35, 95 % CI 0.17, 0.73), but these studies suffer from limitations, including that they were performed for pathological rather than prophylactic purposes. Initial cost-effectiveness modeling indicates that OS is cost-effective over a wide range of costs and risk estimates. While preliminary safety, efficacy, and cost-effectiveness data are promising, further research is needed (particularly long-term data on ovarian function) to firmly establish the safety of the procedure. The marginal benefit of OS compared with tubal ligation or hysterectomy alone needs to be established through large prospective studies of OS done for prophylaxis.

Benefits of salpingectomy for ovarian cancer prevention

Benefits of salpingectomy for ovarian cancer prevention